Perioperative Patient Blood Management (excluding obstetrics): Guidelines from the French National Authority for Health.
Study Goal
The researchers aimed to summarize the French National Authority for Health (HAS) guidelines on patient blood management (PBM) in surgical procedures, focusing on optimizing iron use to manage anemia and reduce transfusions.
Results Summary
The guidelines recommend detecting and correcting iron deficiency preoperatively, using intravenous iron postoperatively for anemia management, and adopting restrictive transfusion thresholds to improve patient outcomes and reduce hospital stays.
Population
Surgical patients, particularly those with moderate to high bleeding risk or preoperative anemia.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
detecting anemia and iron deficiency and taking corrective measures well in advance of surgery | neutral | anemia and iron deficiency | patients with moderate to high bleeding risk or known preoperative anemia | - | recommended | #1 |
use of tranexamic acid | decrease | bleeding | patients with high bleeding risk or in case of hemorrhage | - | recommended to limit bleeding | #2 |
use of cell salvage | neutral | - | patients undergoing some surgeries with a major risk of transfusion | - | recommended | #3 |
limitation of blood samples | decrease | blood samples | postoperative patients | - | recommended | #4 |
monitoring of postoperative anemia | neutral | postoperative anemia | postoperative patients | - | must be carried out | #5 |
corrective measures (intravenous iron in particular) or more precise diagnostic assessment | neutral | postoperative anemia | postoperative patients | - | may lead to | #6 |
restrictive transfusion threshold considering comorbidities and tolerance | neutral | transfusion threshold | postoperative patients | - | recommended | #7 |
implementation of a strategy and a program for patient blood management | decrease | blood transfusion and length of stay | patients throughout the perioperative period in healthcare establishments | - | recommended to reduce | #8 |
The French National Authority for Health (HAS) recently issued guidelines for patient blood management (PBM) in surgical procedures. These recommendations are based on three usual pillars of PBM: optimizing red cell mass, minimizing blood loss and optimizing anemia tolerance. In the preoperative period, these guidelines recommend detecting anemia and iron deficiency and taking corrective measures well in advance of surgery, when possible, in case of surgery with moderate to high bleeding risk or known preoperative anemia. In the intraoperative period, the use of tranexamic acid and some surgical techniques are recommended to limit bleeding in case of high bleeding risk or in case of hemorrhage, and the use of cell salvage is recommended in some surgeries with a major risk of transfusion. In the postoperative period, the limitation of blood samples is recommended but the monitoring of postoperative anemia must be carried out and may lead to corrective measures (intravenous iron in particular) or more precise diagnostic assessment of this anemia. A "restrictive" transfusion threshold considering comorbidities and, most importantly, the tolerance of the patient is recommended postoperatively. The implementation of a strategy and a program for patient blood management is recommended throughout the perioperative period in healthcare establishments in order to reduce blood transfusion and length of stay. This article presents an English translation of the HAS recommendations and a summary of the rationale underlying these recommendations.